The principles and practice of modern surgery / by Roswell Park ... with 722 engravings and 60 full-page plates in colors and monochrome.

  • Roswell Park
Date:
1907
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of modern surgery / by Roswell Park ... with 722 engravings and 60 full-page plates in colors and monochrome. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    41/1200
    TiiRO}fi{nsrs throinhosis occurs pr()inj)(ly. We liavc iinicli to Icurii al)()ut the coafjulatiori of the hlood, l)iit till' ahovc lads arc at least siii^t^cstivc to the siiri;eoii. Causes.—Tlie uiulerlyinij caii.sr ol all tlironihi is, then, (ilUratioii of the nidotliclium. In coiiseiiueiiee, when it is (lesiral)le to |)ro(liice coa<julation artificially, advantage mav he taken of this fact, and mechanical injury to the vessel walls may he (juiekly followeil hy the d(\sircd results. Advantajje is also taken of this fact in surgery, espeeiallv in certain nu-thods of treating aneurysm, hy rude handling, by needling, hy the introduction of horsehairs. Hue wire, etc. A venous thrombosis is certainly favored h\- the thimiess of the venous walls, hy which jjoorer protection is afiorded to their lining endothelium, and infection mori- easily occurs. Arterial thrombosis is favored when cardiac vigor is impaired and vessel walls are thickened so as to obstruct the blood current. This occurs particularly in syphilitic endarteritis, where the intima suii'ers most, and final occlusion is due to the thrombus thus formcil. Arteriosclerosis docs not, by itself, often pro- duce this trouble; it comes rather with atheromatous and calcareous degenerations. The local ischemia which is occasioned by ergotism, by |)ellagra (due to use of certain kinds of maize), by the vasomotor spasm of Raynaud's disease (see under Gangrrnc), by too long-continued constriction, or by frostbite, causes results comparable to tho.se |)roduced experimentally in ])arts supjilied by a teruiinal artery, c. g., in the kidnev after temporary occlusion of its artery. All the tissues involved undergo profound alterations, in which throiubosis figures very largely and may lead to gangrene. While such endothelial lesions are essential, there are, nevertheless, numerous other accessory causes which should be mentioned. These com|irise: A. The presence of foreign bodies, as, for example, needles, booklets of echinococci, parasites, particles of tumors, fragments from the heart valves, and, most of all, that which is essentially a foreign body, a clot which has come from some other point. Around such foreign ]iarticles will quickly group themselves a relatively large number of leukocytes, thus affording another example of ])hagocytosis, soon to be described. Mere slowing of blood stream without some such mechanical irritation is not sufficient to produce coagulation. If, for instance, a section of vein is isolated between two ligatures, the ligation being aseptically tlone and the surroundings of the vein wall disturbed as little as possible, the blood thus shut up within the vein remains fluid indefinitely. If, however, the vessel wall is separated from its surroundings, so that its nourishment is compromised, the contained fluid quickly coagulates. B. Necrosis, gangrene, etc., lead to quick involvement of the endothelium of the vessels contained within the involved part, and consequently to quick coagulation of the blood which they contain. C. Temperature has also an influence in the same direction, and extremes in either direction, or drying of vessels which may happen to be exposed to the air for some time, lead to the same resvilts. I). Infiamviaiory and degenerative processes occurring in and about the vessel walls tend always to produce coagulation. This is well seen in the influence exerted by the so-called atheromatous ^ilcers—i. e., the degeneration of certain areas in the walls of large vessels. E. Microorganisms and their products are perhaps the most frequently effective of all the accessory causes of thrombosis. In other words, in all the surgical infectious diseases we may expect to find more or less, sometimes extensive, thrombosis in the vessels of the afl'ected part. This may so far shut off circulation as to produce tem- porary or permanent edema, or it may lead to gangrene, which may be local or may terminate the life of the patient. Thrombi are classified as: 1. Primari/; and 2. Propagated. The primari/ thrombus is one which has originated at the spot where it has been first produced, and is usually co-extensive with its cause. The propagated thrombus may be one which has been carried to a considerable distance, and is met with at a point widely different from that where it originated, or one which has extended along the vascular channel in which it was first formed, but far beyond the limits of its j)rime cause. When a thrombus attaches itself to a part of the vessel wall it is called parietal or valvular, because it does not completely occlude the vessel; when it involves the entire circumference of the vessel, but does not completely occlude it, it is spoken of as annular.